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PRAMS Prints
No. 6 December 2012
The Pregnancy Risk Assessment Monitoring System (PRAMS), funded by the Centers for Disease Control and Prevention, is an ongoing, state specific, population-based surveillance system of maternal behaviors and experiences before, during and after pregnancy. Developed in 1987, PRAMS was designed to supplement vital records by providing state-specific data on maternal behaviors and experiences to be used for planning and assessing perinatal health programs. Currently conducted in 40 states and New York City, PRAMS collects data representative of 78 percent of U.S. births.
N.C. PRAMS is a random, stratified, monthly mail/telephone survey of North Carolina women who recently delivered a live-born infant. Data collection began in North Carolina on July 1, 1997, providing us with six months of data for 1997. Since 1997, PRAMS data have been collected every year. Each month around 150 to 160 women are selected from the Provisional Live Birth File and are interviewed approximately three to six months after giving birth. All estimates are weighted to reflect the entire population of North Carolina women who gave birth in each year.
www.schs.state.nc.us/SCHS
Year Two Grant Awarded
In spring 2012, we were awarded year two of our five-year cooperative agreement with the Centers for Disease Control and Prevention (CDC) to maintain the PRAMS survey of postpartum mothers. PRAMS is now operating in 40 states and New York City, representing approximately 78 percent of all births occurring in the United States each year. More information on participating states can be found on the CDC website: www.cdc.gov/PRAMS/states.htm.
An Update on PRAMS Survey Operations
The 2012 Revision to the PRAMS Questionnaire
CDC periodically revises the questions and the layout of the survey. Because of the tremendous effort involved in writing and pretesting questions and the need for continuity, these revisions happen infrequently (approximately once every three to five years). Beginning in July 2012, N.C. PRAMS began implementing the Phase 7 revision to the PRAMS questionnaire. The latest revision included the addition of a few new questions, wording changes to existing questions and the arrangement of questions by topic. The survey went from 73 questions in Phase 6 to 78 questions in Phase 7. Additional modifications were made in an effort to clarify areas where there has been some confusion by survey respondents. Most questions on the PRAMS questionnaire remain unchanged, providing a vehicle for those researchers who want to analyze a topic over several years. A copy of the 2012 revised questionnaire can be found on our website at: www.schs.state.nc.us/schs/prams/questions.html.
“PIDS” Implementation and 2012 N.C. PRAMS Data Collection
CDC PRAMS is currently launching a new data entry and collection system, called the “PRAMS Integrated Data Collection System” or “PIDS.” The new system is designed to replace the multiple PRAMS software systems that were used for data collection up until 2012. PIDS development and deployment were intended to coincide with the 2012 birth year data collection and the implementation of the new Phase 7 version of the questionnaire. PIDS deployment was originally scheduled for March 2012, but due to unforeseen delays at the CDC, it will not be implemented until late 2012. As a result of PIDS delays, the CDC postponed deployment of the 2012 PRAMS questionnaire (Phase 7) by four months and 2012 data collection began with May 2012 North Carolina births.
Gift Card Rewards
Research consistently suggests that survey response rates can be substantially improved through the use of monetary or monetary-like incentives and rewards, such as gift cards. We are pleased to announce that thanks to supplemental funding from our PRAMS partners, we will be able to offer $10 Food Lion gift card rewards to mothers that respond to the PRAMS survey in 2012. N.C. PRAMS will continuously monitor our response rates in order to assess the impact of the rewards, but we are optimistic that these will successfully improve our response rates over time.
Annual PRAMS Survey Results on the Web
Survey results from 1997–2010 can be accessed from our website. Disseminating this information to health professionals and the public is a priority of PRAMS and it is our belief that the web is the quickest and most comprehensive means of addressing general data needs. (You can also contact us directly for particular data requests.) Currently our website contains annual data tables, as well as aggregate tables containing PRAMS data for each of the six Perinatal Care Regions in the 2
state. From the N.C. PRAMS website www.schs.state.nc.us/SCHS/prams/index.html, the user can go to “Survey Results” and view data by survey question and year, and obtain results categorized by socio-demographic groups. The website also provides background information on the survey including an overview of the survey methodology, a description of the data collection process and copies of the survey questionnaires.
The following are a few highlights from the 2010 N.C. PRAMS survey:
♦ Thirty-seven percent of new mothers were overweight or obese prior to pregnancy (Body Mass Index of 26.0 or greater).
♦ Thirty-one percent of women reported taking a multivitamin on a daily basis prior to pregnancy.
♦ Seventy-four percent of mothers report placing their baby to sleep on his/her back.
♦ Eighty-two percent of mothers reported that they initiated breastfeeding, but only 56 percent were still breastfeeding eight weeks after delivery.
♦ Twelve percent of mothers reported smoking during the last trimester of their pregnancy.
♦ Twenty-two percent of mothers reported that they did not receive prenatal care in the first trimester of pregnancy.
♦ Forty-five percent of births were unintended (mother did not want to be pregnant then or wanted to become pregnant later). This figure is much higher than the state’s Healthy North Carolina 2020 target of 30.9 percent.
♦ Four percent of new mothers reported being physically abused by their husband or partner during their most recent pregnancy.
Recent Publications Based on N.C. PRAMS Data
State Center for Health Statistics (SCHS) Statistical Services Unit staff recently published a SCHS Statistical Brief on “infant bed sharing”; based on 2009–2010 N.C. PRAMS data. Bed sharing involves the parent or caregiver sharing a sleep surface with an infant, such as sleeping together on a bed, couch or chair. Research suggests that infant bed sharing may be associated with an increased risk for infant deaths, including SIDS, accidental suffocation and overlay. As a result of this research, the American Academy of Pediatrics (AAP) now recommends that
Figure 1. Percentage of North Carolina Mothers Reportin
gUnintended Pregnancies by Age: N.C. PRAMS 2010:Healthy North Carolina 2020 Target=30.9 PercentTotal< 20Years20–24Years25–34Years35+YearsPercent Unintended45.2%83.1%58.3%34.1%32.2%0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%100.0%3
parents and caregivers engage in “room sharing” but not “bed sharing.” Data from 2009–2010 N.C. PRAMS reveal that more than half of North Carolina mothers (65.8%) did not follow AAP recommendations which advise caregivers to never engage in bed sharing with an infant.
The N.C. PRAMS survey found that the characteristics of mothers in North Carolina who report higher rates of infant bed sharing include:
♦ Twenty years of age and younger
♦ Twelve years or less of education
♦ Not married
♦ Non-white (Latina, African American, Other)
♦ Delivery paid by Medicaid
♦ Receipt of WIC benefits during pregnancy
♦ Delivered a low birth weight baby.
To review the full report, please see:
www.schs.state.nc.us/schs/pdf/SB_39_20120620.pdf.
A variety of other publications have recently been published which utilize N.C. PRAMS data. A list of these reports can be found below:
♦ North Carolina PRAMS Fact Sheet: North Carolina Teen Mothers’ Maternal Health 2005–2009 N.C. Pregnancy Risk Assessment Monitoring System: www.schs.state.nc.us/schs/pdf/PRAMS_FS_Teen_Mothers_WEB_20120612.pdf.
♦ PRAMS Surveillance Update: North Carolina Mothers Who Report Having a Blood Test for HIV: www.schs.state.nc.us/schs/pdf/PRAMS_SU_3_WEB.pdf.
♦ Meyer R, Desrosiers T. Utilization of Dental Health Care Services Among Pregnant Women in North Carolina. North Carolina Medical Journal. 2012;73(2):136–9. Available at: www.ncmedicaljournal.com/wp-content/uploads/2012/03/NCMJ_73215-web.pdf.
♦ University of North Carolina at Chapel Hill, Center for Women’s Health Research. 2012 North Carolina Women’s Health Report Card. Available at: http://cwhr.unc.edu/files/report-card-pdfs/rc-2012/2012%20NC%20WHRC%20Interactive.pdf.
♦ Yadok Z, Tanner A, Piper C, Thompson M. HIV Testing Behaviors Among Pregnant Women in North Carolina: A Cross-Sectional Study Using 2008 PRAMS Participants. Paper presented October 29, 2012 at the Annual Meeting of the American Public Health Association. Available at: https://apha.confex.com/apha/140am/webprogram/Paper270399.html.
Figure 2. How Often Does Your New Baby Slee
pin the Same Bed with You or Anyone Else?:N.C. PRAMS 2009–2010Never34%Rarely23%Sometimes17%Often/Almost Always12%Always14%State of North Carolina
Department of Health and Human Services
Albert A. Delia, Acting Secretary
www.ncdhhs.gov
Division of Public Health
Laura Gerald, MD, MPH, State Health Director
www.publichealth.nc.gov
Chronic Disease and Injury Section
Ruth Petersen, MD, MPH, Chief
State Center for Health Statistics
Karen L. Knight, MS, Director
www.schs.state.nc.us/SCHS
For more information about the PRAMS Project contact:
Fatma Simsek at (919) 855-4495
e-mail: fatma.simsek@dhhs.nc.gov
An Equal Opportunity/Affirmative Action Employer
Please share this newsletter with co-workers and
others that you think may be interested.
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699-1908

PRAMS Prints
No. 6 December 2012
The Pregnancy Risk Assessment Monitoring System (PRAMS), funded by the Centers for Disease Control and Prevention, is an ongoing, state specific, population-based surveillance system of maternal behaviors and experiences before, during and after pregnancy. Developed in 1987, PRAMS was designed to supplement vital records by providing state-specific data on maternal behaviors and experiences to be used for planning and assessing perinatal health programs. Currently conducted in 40 states and New York City, PRAMS collects data representative of 78 percent of U.S. births.
N.C. PRAMS is a random, stratified, monthly mail/telephone survey of North Carolina women who recently delivered a live-born infant. Data collection began in North Carolina on July 1, 1997, providing us with six months of data for 1997. Since 1997, PRAMS data have been collected every year. Each month around 150 to 160 women are selected from the Provisional Live Birth File and are interviewed approximately three to six months after giving birth. All estimates are weighted to reflect the entire population of North Carolina women who gave birth in each year.
www.schs.state.nc.us/SCHS
Year Two Grant Awarded
In spring 2012, we were awarded year two of our five-year cooperative agreement with the Centers for Disease Control and Prevention (CDC) to maintain the PRAMS survey of postpartum mothers. PRAMS is now operating in 40 states and New York City, representing approximately 78 percent of all births occurring in the United States each year. More information on participating states can be found on the CDC website: www.cdc.gov/PRAMS/states.htm.
An Update on PRAMS Survey Operations
The 2012 Revision to the PRAMS Questionnaire
CDC periodically revises the questions and the layout of the survey. Because of the tremendous effort involved in writing and pretesting questions and the need for continuity, these revisions happen infrequently (approximately once every three to five years). Beginning in July 2012, N.C. PRAMS began implementing the Phase 7 revision to the PRAMS questionnaire. The latest revision included the addition of a few new questions, wording changes to existing questions and the arrangement of questions by topic. The survey went from 73 questions in Phase 6 to 78 questions in Phase 7. Additional modifications were made in an effort to clarify areas where there has been some confusion by survey respondents. Most questions on the PRAMS questionnaire remain unchanged, providing a vehicle for those researchers who want to analyze a topic over several years. A copy of the 2012 revised questionnaire can be found on our website at: www.schs.state.nc.us/schs/prams/questions.html.
“PIDS” Implementation and 2012 N.C. PRAMS Data Collection
CDC PRAMS is currently launching a new data entry and collection system, called the “PRAMS Integrated Data Collection System” or “PIDS.” The new system is designed to replace the multiple PRAMS software systems that were used for data collection up until 2012. PIDS development and deployment were intended to coincide with the 2012 birth year data collection and the implementation of the new Phase 7 version of the questionnaire. PIDS deployment was originally scheduled for March 2012, but due to unforeseen delays at the CDC, it will not be implemented until late 2012. As a result of PIDS delays, the CDC postponed deployment of the 2012 PRAMS questionnaire (Phase 7) by four months and 2012 data collection began with May 2012 North Carolina births.
Gift Card Rewards
Research consistently suggests that survey response rates can be substantially improved through the use of monetary or monetary-like incentives and rewards, such as gift cards. We are pleased to announce that thanks to supplemental funding from our PRAMS partners, we will be able to offer $10 Food Lion gift card rewards to mothers that respond to the PRAMS survey in 2012. N.C. PRAMS will continuously monitor our response rates in order to assess the impact of the rewards, but we are optimistic that these will successfully improve our response rates over time.
Annual PRAMS Survey Results on the Web
Survey results from 1997–2010 can be accessed from our website. Disseminating this information to health professionals and the public is a priority of PRAMS and it is our belief that the web is the quickest and most comprehensive means of addressing general data needs. (You can also contact us directly for particular data requests.) Currently our website contains annual data tables, as well as aggregate tables containing PRAMS data for each of the six Perinatal Care Regions in the 2
state. From the N.C. PRAMS website www.schs.state.nc.us/SCHS/prams/index.html, the user can go to “Survey Results” and view data by survey question and year, and obtain results categorized by socio-demographic groups. The website also provides background information on the survey including an overview of the survey methodology, a description of the data collection process and copies of the survey questionnaires.
The following are a few highlights from the 2010 N.C. PRAMS survey:
♦ Thirty-seven percent of new mothers were overweight or obese prior to pregnancy (Body Mass Index of 26.0 or greater).
♦ Thirty-one percent of women reported taking a multivitamin on a daily basis prior to pregnancy.
♦ Seventy-four percent of mothers report placing their baby to sleep on his/her back.
♦ Eighty-two percent of mothers reported that they initiated breastfeeding, but only 56 percent were still breastfeeding eight weeks after delivery.
♦ Twelve percent of mothers reported smoking during the last trimester of their pregnancy.
♦ Twenty-two percent of mothers reported that they did not receive prenatal care in the first trimester of pregnancy.
♦ Forty-five percent of births were unintended (mother did not want to be pregnant then or wanted to become pregnant later). This figure is much higher than the state’s Healthy North Carolina 2020 target of 30.9 percent.
♦ Four percent of new mothers reported being physically abused by their husband or partner during their most recent pregnancy.
Recent Publications Based on N.C. PRAMS Data
State Center for Health Statistics (SCHS) Statistical Services Unit staff recently published a SCHS Statistical Brief on “infant bed sharing”; based on 2009–2010 N.C. PRAMS data. Bed sharing involves the parent or caregiver sharing a sleep surface with an infant, such as sleeping together on a bed, couch or chair. Research suggests that infant bed sharing may be associated with an increased risk for infant deaths, including SIDS, accidental suffocation and overlay. As a result of this research, the American Academy of Pediatrics (AAP) now recommends that
Figure 1. Percentage of North Carolina Mothers Reportin
gUnintended Pregnancies by Age: N.C. PRAMS 2010:Healthy North Carolina 2020 Target=30.9 PercentTotal< 20Years20–24Years25–34Years35+YearsPercent Unintended45.2%83.1%58.3%34.1%32.2%0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%100.0%3
parents and caregivers engage in “room sharing” but not “bed sharing.” Data from 2009–2010 N.C. PRAMS reveal that more than half of North Carolina mothers (65.8%) did not follow AAP recommendations which advise caregivers to never engage in bed sharing with an infant.
The N.C. PRAMS survey found that the characteristics of mothers in North Carolina who report higher rates of infant bed sharing include:
♦ Twenty years of age and younger
♦ Twelve years or less of education
♦ Not married
♦ Non-white (Latina, African American, Other)
♦ Delivery paid by Medicaid
♦ Receipt of WIC benefits during pregnancy
♦ Delivered a low birth weight baby.
To review the full report, please see:
www.schs.state.nc.us/schs/pdf/SB_39_20120620.pdf.
A variety of other publications have recently been published which utilize N.C. PRAMS data. A list of these reports can be found below:
♦ North Carolina PRAMS Fact Sheet: North Carolina Teen Mothers’ Maternal Health 2005–2009 N.C. Pregnancy Risk Assessment Monitoring System: www.schs.state.nc.us/schs/pdf/PRAMS_FS_Teen_Mothers_WEB_20120612.pdf.
♦ PRAMS Surveillance Update: North Carolina Mothers Who Report Having a Blood Test for HIV: www.schs.state.nc.us/schs/pdf/PRAMS_SU_3_WEB.pdf.
♦ Meyer R, Desrosiers T. Utilization of Dental Health Care Services Among Pregnant Women in North Carolina. North Carolina Medical Journal. 2012;73(2):136–9. Available at: www.ncmedicaljournal.com/wp-content/uploads/2012/03/NCMJ_73215-web.pdf.
♦ University of North Carolina at Chapel Hill, Center for Women’s Health Research. 2012 North Carolina Women’s Health Report Card. Available at: http://cwhr.unc.edu/files/report-card-pdfs/rc-2012/2012%20NC%20WHRC%20Interactive.pdf.
♦ Yadok Z, Tanner A, Piper C, Thompson M. HIV Testing Behaviors Among Pregnant Women in North Carolina: A Cross-Sectional Study Using 2008 PRAMS Participants. Paper presented October 29, 2012 at the Annual Meeting of the American Public Health Association. Available at: https://apha.confex.com/apha/140am/webprogram/Paper270399.html.
Figure 2. How Often Does Your New Baby Slee
pin the Same Bed with You or Anyone Else?:N.C. PRAMS 2009–2010Never34%Rarely23%Sometimes17%Often/Almost Always12%Always14%State of North Carolina
Department of Health and Human Services
Albert A. Delia, Acting Secretary
www.ncdhhs.gov
Division of Public Health
Laura Gerald, MD, MPH, State Health Director
www.publichealth.nc.gov
Chronic Disease and Injury Section
Ruth Petersen, MD, MPH, Chief
State Center for Health Statistics
Karen L. Knight, MS, Director
www.schs.state.nc.us/SCHS
For more information about the PRAMS Project contact:
Fatma Simsek at (919) 855-4495
e-mail: fatma.simsek@dhhs.nc.gov
An Equal Opportunity/Affirmative Action Employer
Please share this newsletter with co-workers and
others that you think may be interested.
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699-1908